Tuberculosis (TB)

We learnt briefly about TB in AS Biology this week so I thought I would do a small bit of research on the disease and write briefly about it here.

It is an infectious disease transmitted by airborne droplets of Mycobacterium, usually Mycobacterium tuberculosis however it is not highly infectious and additional circumstances often contribute to its spread, for example overcrowding, poor housing or an already weakened immune system.

The disease can affect any area of the body but it is usually the lungs that are affected. The alveoli cells become infected and damaged, as do the surrounding blood vessels. This can lead to the coughing up of blood and pus (which can be fatal) but is often prevented by the use of antibiotics.

These antibiotics need to be taken continually for at least 6 months – a regime which is much harder to implement in less developed countries. In addition a resistance is being observed in some cases (due to patients not finishing the full course of antibiotics for whatever reason) so the use of dual antibiotic treatment may occur.

Whilst researching I came across this article, showing an 8% rise in cases in London. It is thought to be caused by an increase in homelessness in the city (poor housing is one of the influencing factors I discovered earlier). Migration could also influence in the spread of the disease, with people migrating to London from less developed countries where the disease is more common. 

Mock interview

This week I had my first medical interview experience which I found nerve-racking but also very worth while! The interview lasted around 25 minutes and involved a one on one question and answer session with a consultant neurosurgeon.

I thought I would briefly share some of the questions I was asked (other than the obvious ones such as "Why medicine?" and "Tell me about your work experience")  to get you thinking! For example:

- "How would you compare healthcare here in the UK with healthcare in a less developed country, what are the major differences?"

- "What are the main reasons for the great advancements in medicine since the late 1800's / early 1900's?"

- "If I were to give you £1,000,000,000 which single area of medicine would you spend it on?"

-"Do you know anything about diabetes?" which eventually progressed to "How would you tell a 10 year old they had type 1 diabetes?"

- "How would you make a hip replacement and why?"

At the time I was unsure how to answer some of the questions but tried my best to do so and the interviewer would hint if necessary and probe for further detail to see how far I could take the idea!

After feedback at the end of the interview the most useful tip I received was that often the interviewer doesn't expect you to know the answer to the question they're asking and there may be no correct answer either but they are interested to see how you go about solving problems and the way in which your thought processes work. In addition having made the mistake myself I was told if you have absolutely no idea or very little idea about the matter they're asking about it is often better to say so rather than giving a vague answer and they will ask you about something else instead.

I hope some of this will be useful to you! If anyone has had similar experiences - get in touch!

Fabrice Muamba

Yesterday Fabrice Muamba, a top athlete in premier league football collapsed suddenly (with no other players around him) and now remains anaesthetised in hospital and will be for at least 24 hours. Doctors and paramedics on the pitch soon realised this was no ordinary football injury and were quick to act. Muamba had suffered from a cardiac arrest and doctors spent 6 minutes trying to resuscitate him on the pitch, they then tried to revive him using a defibrillator in the tunnel and were finally successful in doing so on route to hospital.

The cause of the arrest is currently unknown but one possible cause is hypertrophic obstructive cardiomyopathy (or "hocum" as its nicknamed).

In hocum a genetic abnormality causes the muscular wall of the heart to grow far thicker than it is supposed to. Repeated vigorous exercise (for example that of a professional athlete) makes matters worse, causing the wall to become so thick that it stops the normal flow of blood through the heart. Obviously this is very dangerous and can be life threatening.

A malfunctioning heart pump usually causes problems in far older or less healthy people however although an athlete with hocum might seem very fit their heart is in fact struggling severely. Sudden strain, such as a sports fixture demands an overwhelming effort and often the first signs of trouble are rapid, for example collapse.

The heart's ability to pump has been compromised in such a way that it can no longer beat in the co-ordinated manner it's supposed to and therefore cardiac arrest occurs.

My thoughts are with Fabrice Muamba and his family, hoping he recovers.

Locked-in Syndrome

Locked-in Syndrome has been in the news recently surrounding Tony Nicklinson (a 7 year suffer from the condition) so I thought I would write briefly about it this week.

It is a condition in which the patient is unable to speak, is completely paralysed (except for eye movements) but remains conscious and usually results from a very serious brain hemorrhage. A famous suffer who you may have heard of is Jean-Dominique Bauby who wrote an entire book entitled The Diving Bell and the Butterfly in 10 months (4 hours/day), only using his left eyelid whilst suffering from locked-in syndrome.

This week a judge ruled that Tony Nicklinson's desire for a doctor to be able to lawfully end his life is a case which will go to a full hearing in court where medical evidence can be heard. (This also relates to my previous article on Euthanasia and assisted suicide.) I won't regurgitate the article but if you wish to read more about this interesting case click here

Following this story there was a locked-in syndrome "recoverer" on BBC breakfast this morning who describes her experiences amongst other things which is also very interesting! Click here for the video

Difficult scenarios faced by a Neurosurgeon!

This week I attended a fascinating talk given by a consultant Neurosurgeon. He talked about the attributes a good doctor should have, attempting to get into medical school, his personal journey into Neurosurgery, showed us two videos from theatre (which were very interesting but difficult to understand due to the complexity of the brain!) and described some scenarios he has faced as a consultant which required some of the attributes he described earlier and asked us how we would have dealt with them. Both are difficult to deal with in their own way and have stuck in my mind since the talk.

1.) A 50 or so year old well educated man has been diagnosed with a brain tumour. After discussing his options with you he agrees to undergo an operation to remove it. You see him in clinic a week after the surgery with his entire family. You bear the bad news that the tumour is in fact cancerous and cannot be cured however it can be controlled with additional treatment. If he has the treatment there is a good chance he will live for at least 2 years and a small chance that he will live for 5 years. However he makes the decision that he wants to die and despite encouragement from his family refuses any further treatment and dies 4 months later.

2.) A 35 year old architect has been diagnosed with a brain tumour. He and his female partner visit you to talk about surgery. He agrees to undergo an operation to remove it and accepts the risks of possible weakness of the arm/leg and mild speech difficulty. He is extremely anxious about the surgery and whether or not this tumour is cancerous. 2 days later the partner arranges to see you separately and tells you that she is 4 weeks pregnant however she is planning to abort the baby as she is worried that if her partner's tumour is cancerous he may not be around long enough to be a father to the child. She wants to know from you exactly what his chances are of being the same person he is now after surgery and has already made an appointment at the abortion clinic next week.

If you had been the surgeon how would you have dealt with the situations? How would they have made you feel?